The Patient Protection & Affordable Care Act (PP ACA) Will it Help Public Health? American Association of Public Health Physicians San Francisco, CA, October.

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Presentation on theme: "The Patient Protection & Affordable Care Act (PP ACA) Will it Help Public Health? American Association of Public Health Physicians San Francisco, CA, October."— Presentation transcript:

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The Patient Protection & Affordable Care Act (PP ACA) Will it Help Public Health? American Association of Public Health Physicians San Francisco, CA, October 28, 2012 Jonathan Weisbuch, MD, MPH

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Agenda  History behind ACA  Problems in the PH System  PP ACA Benefits to Public Health  The Future: The Election of 2012 Will we Keep What We Have, Regress, Or Expand PH & Medicare for ALL?  History behind ACA  Problems in the PH System  PP ACA Benefits to Public Health  The Future: The Election of 2012 Will we Keep What We Have, Regress, Or Expand PH & Medicare for ALL?

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What About TAXES?  Congress may use a Tax to Achieve its OBJECTIVE  IMPLICATION for Pub Hlth  A Tax can be used for PH goals  A Tax can Influence Behavior  Tax is triggered by a Situation  Invites Targetted Taxes  Congress may use a Tax to Achieve its OBJECTIVE  IMPLICATION for Pub Hlth  A Tax can be used for PH goals  A Tax can Influence Behavior  Tax is triggered by a Situation  Invites Targetted Taxes

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Some Examples  Tax on Tanning Salons  Tax on Pollution  Taxes on Tobacco & Alcohol  Or a TAX on PEOPLE who SMOKE  A Tax on Body Mass,  Or a Tax Credit for Weight LOSS  Or a Credit for Vaccinating Children  And More….  Tax on Tanning Salons  Tax on Pollution  Taxes on Tobacco & Alcohol  Or a TAX on PEOPLE who SMOKE  A Tax on Body Mass,  Or a Tax Credit for Weight LOSS  Or a Credit for Vaccinating Children  And More…. Ref: Mello, MM, & Cohen, IG, NEJM.org, Oct 17, 2012

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But Caveats Exist  Taxes can be used for PH Goals  But they can be Blocked as Well  Legislatures do not always Agree  Nor do the VOTERS who may Balk  Taxes can be used for PH Goals  But they can be Blocked as Well  Legislatures do not always Agree  Nor do the VOTERS who may Balk BUT the Supreme Court Decision Will Not Determine the FUTURE

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Option #4 US House Dem: 225 Rep: 205 US Senate Dem: 55 Rep: 44 Ind: 1 O b a m a President O b a m a Is Re-elected

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Given Four Options, What is the FUTURE for Public Health & Health Care after 2012? Republicans will Repeal ACA; Privatize Medicare and Eliminate Medicaid Affordable Care Act will be Solid; Medicare for All ; might be Considered. Medicaid, WHO KNOWS?? Option 1 or 2: Who Knows? More Gridlock? Option 3:Option 4: PUBLIC HEALTH. Could Prosper

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If Public Health is to Prosper, We Must Achieve Option #4 AMA, APHA, NACCHO, ASTHO, APPHP  We must then work with Congress; through AMA, APHA, NACCHO, ASTHO, APPHP POLITICAL  We must continue to work our local POLITICAL Game,  If Obama loses, we will be in entrenchment mode. AMA, APHA, NACCHO, ASTHO, APPHP  We must then work with Congress; through AMA, APHA, NACCHO, ASTHO, APPHP POLITICAL  We must continue to work our local POLITICAL Game,  If Obama loses, we will be in entrenchment mode. We Must Work to Improve the ACA. Work to Prevent Repeal

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US History Merchant Seaman’s Act of 1798 buy Signed into Law, the Merchant Seaman’s Act of 1798, which Required all Seaman to buy Insurance giving the US the resources to create a Federal Health System in all US Seaports, serving Seamen and other Federally qualified groups, President John Adams, 1798 It became the basis for the Public Health Service; and the VA Hospital System.

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Early 20th Century History TR, Franklin & Harry All failed to pass Universal Health Care

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More History LBJ: In 1964 the Election Mattered And LBJ signed Medicare & Medicaid in Independence, MO, July 30, 1965

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Painful History Clinton Clinton: The Failure of Clinton’s Health Reform Legislation, opened the Flood Gates to an Expanded Private Health Insurance Industry

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And Yesterday’s History President Obama, in 2010, Patient Protection Affordable Care Act, ACA with a Democratic Majority in the House and Senate Signed the Patient Protection Affordable Care Act, ACA March 23, 2010